Aeromedical Evacuation Crews Score Their First Flight Simulators

Aeromedical Evacuation Crews Score Their First Flight Simulators

Combining aviation and healthcare simulation into one experience? That’s the power of working with CAE Healthcare! In today’s story we share how the Air Force is combing simulation experiences for both aviation and healthcare crews:

In the back of a C-130 Hercules, a woman is giving birth. Like many other women, she is confused and nervous during the process, lashing out when a nurse touches her arm and anxiously calling out for her baby after delivering.


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As lifelike as the scenario is, almost everything about the situation is fake, from the aircraft itself — actually a training system meant to replicate the fuselage of the C-130 — to the woman, a mannequin capable of blinking, speech and delivering a small mannequin baby. To the military nurses and medical technicians taking care of the clockwork woman and her newborn, this is as close to real as they can possibly get until they’re face-to-face with a human patient.

Air Force pilots typically practice their skills via ground-based fuselage trainers, as do many specialized crew positions like the C-17 loadmasters responsible for air dropping supplies. But until just recently, aeromedical personnel were forced to rely on either flight-based training or less immersive ground-based simulations where they would act out scenarios in a normal classroom, said Lt. Col. Chad Corliss, deputy commander of the 94th Aeromedical Evacuation Squadron.


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Aviation’s Black Boxes Are Coming to Healthcare Training

black boxes in healthcare

This summer I was thrilled to provide the SESAM closing plenary address where I shared the past, present and future of healthcare simulation — and made direct calls for healthcare to integrate a “blackbox” into healthcare. The argument is simple: recording devices have been successfully improving aviation training and performance outcomes since the 1970s — and in a day and age where police body cameras are becoming affordable for every single officer, clearly healthcare is on a similar path. Today here is more support for such a conversation from Richard Corder, Partner at Wellesley Partners which provides Executive Coaching in Boston and throughout the Northeast:

There are many industries, other than healthcare, that work in complex environments where the actions of one human can impact the life of another. Healthcare leaders need to acknowledge the reality that we have much to learn from other industries. While we cannot mimic others entirely, the same general operating principles (including mindfulness that serves as the overarching organizational spirit) that are the foundation for other high reliability organizations (i.e.: aviation, nuclear power) can work just as well to prevent harm from occurring in health systems.

One example of a safe practice or technology that could shared across industries is the in-flight data recorder found on all commercial airliners. It was because of the in-flight data recorder on board the two Boeing 747s that crashed into one another on the island of Tenerife in 1977 that we learned so much about the decisions and behaviors resulting in that game-changing airline disaster.  The time stamped voice commands of those at the controls were captured in real-time, and provided a blueprint of what “not to do” along with a snapshot of what needed to be changed.

Now envision this: following a surgical procedure, regardless of the outcome, we have the opportunity to review every piece of data related to the procedure.

Read the full article on Healthcare Executives Network

Help Fund Movie That Connects Aviation Simulation to Healthcare Simulation

aviation team training into healthcare

IndieGoGo, a crowd-funding platform for independent projects, is hosting the opportunity to donate towards: “Beyond the Checklist: A Feature Length Documentary Film”, which explores how lessons from industries like aviation can provide solutions to the crisis of patient deaths and injuries in healthcare. I urge you to join me in pledging towards this important documentary film which will attempt to show how training in the aviation business using evolved communication practices has lead to an incredible safety record, especially in comparison to the number of deaths attributed to medical error now occurring in the United States.

The Concept Behind the Film:

“On January 9, 2009. US Airways Flight 1549 landed in the middle of the frigid Hudson River in New York. Captain Chesley “Sully” Sullenberger and his crew – as well as ferry and Coast Guard crews – had all practiced and trained in teamwork for years. Which is why not a single passenger or crew- member was seriously injured when the plane was totally disabled when struck by a flock of Canada Geese.

Our 60-minute film will demonstrate that healthcare can transform its culture and stem the epidemic of medical errors and injuries in the US and elsewhere. It can do this by learning lessons from the safety model and culture change movement that transformed commercial aviation over the last 30 years and that has been successfully adapted to make other high-risk industries much safer. The film “Beyond the Checklist” shows exactly how this safety model and culture can be implemented in the healthcare industry.

Take a trip on a $14 million dollar flight simulator, and see how pilots, fight attendants, ground crew, and air traffic controllers all learn to work together to make air travel safer. Sit in on training sessions that teach people on very different rungs of the health care hierarchy how to communicate so they can form quick teams and react instantly in crisis. Here, pilots aren’t only graded on how well they guide a plane during both routine flights and crises but on how well they communicate and work as a team with their crew. Flight attendants mechanics, and gate agents and many others learn to speak up when appropriate and challenge each other, as well as the captain and rather than experiencing “push back,” they are thanked for it.

“Crew Resource Management gave you a process and a language…so that if I said to you, captain I’m not comfortable with this, he had to hear that because it was done in a way that we were all trained,” recalls Nancy Burns, who was a flight attendant for 39 years both and experienced the change in culture when aviation introduced CRM. “It meant that if you spoke up they had to listen. It also meant that you had a responsibility to speak up.” Airline personnel are also encouraged to report mistakes – even serious violations – without being punished and all airlines share information about near misses, errors, and other problems to change practice and insure safety.

The film concludes by showing how the lessons of these pioneering practitioners and institutions can be implemented in every single hospital and health care facility so that every patient everywhere is safe. Each and every one of us will someday be a patient. Our lives and the lives of our loved ones depend on whether our caregivers are trained to work together as a team, can learn together to prevent mistakes, and are able to create a culture of safety in healthcare.”

Click here to learn more and donate to the Beyond the Checklist Documentary Film!


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Saab Simulation & Training Centre Preps Soldiers for Future Wars

saab military simulation

News.com.Au brings us inside the Swedish simulation training center to share about the technology, the training benefits and cost-savings of modern day military and police lessons from Saab. Saab, I just realized, does a lot more than build cars by providing medical, air, land, naval and civil security simulation training to programs around the world.

Article Covers Military Simulation Technology & Benefits:

During a media tour of the firm’s facilities across Sweden in early April, News Corp Australia witnessed first-hand the incredible advances in simulation technology from digital weapons ranges to an entire village fully instrumented to simulate any number of scenarios from hostage rescue to a full-blown live fire assault.

Today’s advanced simulation and live instrumentation systems can be transported in trailers to units at their home locations with a minimum of fuss and at a greatly reduced cost. With shrinking budgets across all areas of government, including the military, the sheer cost of moving hundreds of soldiers and equipment long distances to conduct live training has become so prohibitive that portable and fixed simulation will take over many traditional training roles.

Just one example of the huge potential for savings that simulation brings is the training of Joint Terminal Attack Controllers or JTAC’s. These highly trained soldiers are the eyes and ears on the ground to call in close-air support for infantry troops in the form of fast jets or attack helicopters. The cost of training just one JTAC is estimated at $19 million when you tally up aircraft and ammunition costs. Modern simulation technology means you can take a JTAC to the same skill level for a fraction of that cost.

Saab employs about 700 people in its training systems and simulation division including about 350 engineers and according to company spokesman Anders Jonzon the philosophy of simulation is simple — to allow soldiers or police to train as they will fight. “We are turning training into confidence,’’ he said, “If we can save a life that is what we intend to do.’’

Politicians who send troops to war don’t want too many coming home in body bags so saving lives is a vital element of modern training for war. According to Saab it can prove how simulated training systems have saved lives.

SAAB “Medical Treatment Simulator” 

saab mts
Check out the MTS from Saab

A combat medic must be trained to determine who is most seriously injured. The Medical Treatment Simulator provides support for treatment prioritisation and improves the basic wound simulation capabilities in Saab’s Personnel Detection Devices. The simulator software is used in a handheld computer in the field for simulated examination and treatment of soldiers.

Read the full press article on News.com.au and visit the Saab Simulation and Training Centre here.

Some Physicians Continue to Ignore Learning Opportunity From Aviation Simulation

airway chart

Suzanne Gordon, author of Beyond the Checklist: What Else Can Healthcare Learn from Aviation Teamwork and Safety, recently wrote up an article entitled “…just two guys in a box” – Really?” which focuses on her frustration when healthcare physicians criticize the training take-aways from aviation without true understanding.

“As we have gone around the country discussing our book Beyond the Checklist: What Else Health Care Can Learn from Aviation Teamwork and Safety, we have been struck by the number of people who insist that healthcare has little to learn from aviation because the two enterprises are entirely different. Critics suggest that healthcare is far more complex than aviation. One physician in charge of simulation at a large medical school blithely opined that really “in aviation, it’s just two guys in a box.” Another physician insisted that “…flying a 747 is really no different than flying a Cessna.” On further inquiry, we learned that he had done neither. Even many who are somewhat sympathetic to our message believe that healthcare and aviation have little in common.

This idea has likely taken root because people do not understand the complexity of the global system of aviation safety in which each individual flight is embedded. People think of an airplane flight as an individual, discrete entity: Plane takes off, plane lands. Just two guys in the box get it off the ground and back on the ground, and with remarkably few glitches – this happens day in and day out. This idea is reinforced each time we look up at the sky and see this vast expanse of blue (or gray if you live in Seattle as Patrick does) with maybe the odd airplane skimming the horizon. What the individual standing on the ground does not see are the many, many airplanes that are up in the sky at 28,000 to 60,000 feet, all of which function in the same kind of interconnected system that patients in a hospital or other complex facility depend on.”


Organizing the World’s Flights Everyday

Suzanne provides multiple examples of the difficulty of flying, before continuing that the differences in the content of learning is not what should be in question regarding such a conversation — but rather the structure of culture and training.

How can the responsible parties in any industry or organization best function to protect those who depend on their skills and professional judgment for survival? We can learn from best practices and relevant models wherever and whenever they are developed and then adapt them to different settings in which they may be useful. What is paramount is how an institution—or, in the case of CRM, an entire global industry—learned to change for the better and for the safer and how it has sustained change over time. What did the airline industry do concretely to transform workplace relationships and create a different model of workplace hierarchy and teamwork? How did it confront power and status differentials and learn to help people speak up about safety without fear of reprisal? What strategies and tactics did it utilize, what obstacles did it confront and overcome, and what values and practices did it change—and how? We also believe that, in spite of the differences between healthcare and aviation, the principles of CRM—learning to communicate more effectively, learning to lead a team and work effectively on a team, as well as learning to manage stressful workloads and anticipate a variety of threats to safety, as well as to prevent, manage or contain error—are crucial in healthcare and can and should be taught to and learned by all who care for the sick and vulnerable.

We think you’ll appreciate this argument even more if you consider the complexity of what happens up there while you are down here. Or what happens up there to get you back down here safely. Aviation, with all its system complexity managed to transform a toxic and dysfunctional culture over thirty years ago. We believe, as healthcare acknowledges its own similarities to where aviation was, those lessons can be similarly and very effectively applied. “

Read Suzanne’s full article and many more at her website http://suzannecgordon.com/


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USAF Utilizes Simulation to Train Past Budget Cuts

us air force

From DefenseNews.com:

If one thing has become clear under sequestration, it is this: Budget cuts beget training cuts, which in turn hurt readiness. The US Air Force in particular has been impacted, with large swaths of its fleet grounded last year and unable to fly crucial training missions. Under that budget reality, the service — and the rest of the Pentagon — is focusing on simulation as a low-cost training alternative, a move made possible by improved technology.

That mix is a “perfect storm” of new technologies, financial need and new capabilities coming online throughout the Pentagon, according to Air Force Col. Franz Plescha, commander of the Air Force Agency for Modeling and Simulation.

“There is a huge upswing,” he said. “We’ve kind of turned the corner. People have had this vision for years, and now it’s all coming together that this is definitely the future.”

Sequestration was “a straw on the camel’s back,” but Plescha said it is unfair to argue that budget cuts forced a move to more simulation. Doing so argues that “we can’t afford to do it a better way, therefore we’re going to do this. And that’s the wrong perception to have. It may have been one of the reasons that got us to turn the corner, but by no means is it the only reason.”

Baptiste said he sees the simulation business expanding in the coming years.

“The current budget environment is going to cause all of the services to relook at the balance of live and simulated training,” he said.” The amount you dedicate to each is going to start to move closer together.” But is there a saturation point for the training market? “I would say the only limitations we have is our own imagination,” Baptiste said. “There will never be zero requirement for training.”

The different services are all committed to simulation, but Baptiste highlighted distributed mission operations — networked simulators — as one area in which the Air Force is advanced.

Linking simulators for joint training operations has been going on for over a decade, according to Plescha. What has changed, he said, is the ability to integrate simulation and live training. Simulation works best when realism is necessary, according to Cummings, who points to situations such as mechanical work or driving a large ship as appropriate. It’s also useful for training people on collaborative decision-making processes, such as squad training, that require audio or gestural queues during the training.

“The thing that you need to think about when thinking of simulation is, ‘what kind of perceptual feedback are you getting when using a simulator?’ ” he said. “Sometimes it’s very important to have very realistic feedback when you’re making decisions.”

The military, of course, isn’t just platforms. New uses for simulation and mobile training are infiltrating everything from training security patrols and joint terminal attack controllers to finding new ways of helping post-traumatic stress disorder sufferers. In some cases, the military can borrow heavily from the civilian side, including in the medical realm, where doctoral students are learning how to identify diseases and dissect patients without needing a cadaver. It also creates new market potential for companies interested in this kind of training.

“Much of the Air Force focus you’ll find in medical,” Golson said. “Medical will explode, absolutely explode. There is a big push right now for all things medical simulation.”

“Still,” Plescha said, “too often when we speak about [simula­tion], people revert to simulators. Virtuals can be not just simulators. It can be the medical dummy that’s on a table. And I’d rather have a doctor practice on a dummy than me.”

Read the full article on DefenseNews.com!

Forbes: “Miracle on the Hudson” Pilot Capt. Sully Works on Patient Safety

Robert J. Szczerba, contributor to Forbes and founder of Simulation-based “X Tech Ventures” has written a great piece on the recent work of Captain Sully – the pilot who successfully landed a engineless plane in the hudson river saving all 155 passengers back in 2009. Captain “Sully” Sullenberger is working with John Hopkins to explore patient safety issues.

sully-patient-safety

Szczerba writes “What lessons on patient safety can be taught by thought leaders from such diverse domains as aerospace, consumer research, defense, nuclear power, education, and hospitality? These were some of the intriguing questions explored last week at the inaugural Forum on Emerging Topics in Patient Safety, jointly sponsored by the Johns Hopkins Armstrong Institute for Patient Safety and Quality and the World Health Organization.

[At the event] Dr. Peter Pronovost, Johns Hopkins Medicine Senior Vice President for Patient Safety and Quality, is one of the nation’s leading advocates for patient safety. During his keynote address, Pronovost explained that “… medical errors and preventable patient harm is the third leading cause of death in the United States and contributes to an estimated $800 billion—one third of all health care costs—spent each year on unneeded or inefficiently delivered care.” Click here to read how patient deaths due to medical error have increased to 220,000-440,000 every year.”

Szczerba continues “Captain Sully & each of the speakers described safety-related challenges in their own fields, and encouraged discussions as to how they might be applied to the clinical environment, with a focus on:

  • Designing safe and highly reliable systems of care delivery
  • Ways to quickly disseminate and incorporate best practices in the areas of safety and quality
  • Developing performance measures that are meaningful to patients, providers, payers, and regulators

The most interesting revelation was that the technologies and processes needed to reduce patient harm already exist and have been proven in other industries time and time again.  The obvious imperative for healthcare is to leverage these best practices to change the underlying culture.”

Read all of Robert’s Article on “Captain ‘Sully’ Sullenberger and Johns Hopkins Tackle Patient Safety” here.

Captain Sully also wrote an introduction to Beyond the Checklist: What Else Healthcare Can Learn from Aviation – and you can read my full book review of this amazing work here!


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Beyond the Checklist: What Else Healthcare Can Learn From Aviation Book Review

suzanne gordon book review

I met Suzanne Gordon, lead author of “Beyond the Checklist: What else Healthcare Can Learn From Healthcare”, at the speaker’s reception of CAE Healthcare’s 2013 HPSN event in San Francisco. At that time, we had a lengthy conversation about the need to reform healthcare communication using proven methods and the opportunity inherent with medical simulation to help to do so.

beyond the checklist book review

Suzanne graciously provided me a copy of her book to review, which I can tell you now is a definite MUST-READ for anyone engaging within any avenue of healthcare, education, and/or simulation. This book goes beyond highlighting key examples of the poor communication practices causing systemic failures within healthcare by also providing a direct roadmap to solve these archaic human-made challenges. The authors poignantly remind us that the status quo of healthcare communication can no longer remain “just the way it is”.

In Beyond the Checklist, Suzanne Gordon:

  1. Diligently lays out the crisis of communication failures occurring within healthcare.
  2. Reminds us of the history of similar communication failures within commercial aviation.
  3. Demonstrates the 30+ year process of research, program development, and training systems implemented within aviation with regards to communication and team-management.
  4. Powerfully explicates “Crew Resource Management” (CRM) as an evolved system for team interactions and operational success.
  5. Highlights successful uses of the initial healthcare version of CRM called TEAMSTEPPS.
  6. Directs our attention to the unavoidable future of healthcare including regulatory bodies and advanced data-capturing systems.

Most incredibly, Suzanne and her co-authors break down the individual components that make up successful team communication, demonstrates how those pieces are failing within healthcare structures, and provides direct examples of how those issues have already been successfully addressed within aviation.

Read some of the excerpts below to better understand the benefits of this work:

“In medicine it seems now to be universally acknowledged that failures of teamwork and communication-not simply failures in technical proficiency-cause the majority of medical errors and injuries in hospitals and other health care facilities. Studies too numerous to cite have documented that it is not the incompetent surgeon or a small group of bad apples in other disciplines that cause harm to patients. It is human factors – the failure of human beings to relate effectively and productively with one another highly technological settings, to recognize human limitations in performance ability owning to “Life factors” such as extreme fatigue and emotional distress, and to actively resist the culture of blame- that are the major cause of patient harm.” p. 8.

“Even when early pilots flew with a navigator, contact was difficult and minimal. From aviation’s inception as a mode of transport, teamwork was rarely a consideration. A large part of pilot training, whether conducted in military, commercial, or general aviation arenas, is often accomplished one-on-one as flight instructors demonstrate and students unquestioningly mimic technical maneuvers-and especially behaviors. The first major milestone in any pilot’s advancement is to fly solo. Until the introduction of CRM in commercial aviation, a pilot’s primary demonstration of competency was based almost entirely on technical aptitude: the ability to perform a standard set of maneuvers and handle emergences (with little or no regard for interaction with the rest of the crew). Although commercial transport pilots flew as crews, competence had little to do with teamwork or error management in the cockpit.” p. 24.

“The aviation safety moment started out precisely because pilots did not accept their human fallibility. Mistaking the end of a very long journey for its beginning, many in medicine do not seem to understand the similarities between attitudes of pilots pre-CRM and those of physicians today. CRM did no succeed because in the 1980s pilots at United and other airlines threw their hands and said, “We give up.” A great many pilots, in fact, dismissed CRM as “Charm school”… to erode their authority. Flight attendants were also initially skeptical. The fact that human fallibility is now universally accepted in aviation is the result of a very long journey that began with a challenge to an ethos that led pilots to believe they had the power of Zeus when, in fact, many only had the hubris of Icarus. The aviation safety movement has worked not only because of the concrete lessons it teaches but also because of the reconceptualization’s ands strategic approaches it has utilized. These have been derived from, and refined through, thirty years of hands-on, human-factors research-in other words, evidence-based changes and developments”. p. 157.

Again, this 261 page book is a MUST READ for anyone engaging in medical simulation today!

Get the softcover version of Beyond the Checklist or the kindle edition through Amazon.com.

Continue reading more great examples of the content available in Suzanne’s book by “Reading More” below.

Read the rest of this entry »

Top 10 Medical Simulation Articles Of Spring 2013

top ten medical simulation articles

HealthySimulation.com is dedicated to providing free resources to healthcare educators considering or utilizing simulation to educate and train professional providers. Here is a list of our most-read medical simulation articles from the first half of 2013:

  1. Video Update from Laerdal SUN Indianapolis 2013 – The April 2013 Laerdal SUN Indianapolis meeting held its opening ceremonies yesterday providing over 230 Simulation Champions from around the World with the training they need to start or expand their healthcare simulation program. Learn more about Medical Simulation by watching this event video recap.
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  2. Collaborative Simulation Program Development Session Provided with FREE HealthySim Subscription – Gain access to a 2-Hour HD recorded stream from the HealthySimAdmin event which covers collaborative program development across disciplines and institutions by subscribing to HealthySimulation.com’s free monthly newsletter, summarizing all the best articles straight to your email inbox!
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  3. HealthStream Provides Free WhitePaper “Right Time for Simulation” Are you associated with a hospital system looking to start or expand a medical simulation based program?  HealthStream just released a free white paper entitled “It’s the Right Place and Right Time for Simulation” on their blog which can help demonstrate the serious benefits of clinical simulation. You can also check out my comprehensive Demonstration of the HealthStream SimManager platform developed to administer simulation staff, equipment, rooms, learners and outcomes.
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  4. Learn How Simulation Has Been Fully Adopted & Integrated in both the Airline Industry and the Nuclear Power Industry – While medical simulation is rapidly expanding, the adoption of the methodology does not even begin to compare to the aviation or nuclear industries. Learn how simulation works in these sectors to better learn why simulation is the future of healthcare education.
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  5. Learn How to Identify Key Drivers for Simulation Training – Key drivers are “an effective tool for breaking down complex questions or improvement goals and structuring them into smaller, addressable pieces”. Learn more about this workshop and download free tools that can clarify simulation needs and appropriate intervention designs for simulation training.
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  6. Increase Realism to Your Simulations Through Background Noise and Advanced Moulage Makeup Kits – By creating the most realistic simulation scenarios learners become fully immersed in the experiential educational experience. Small considerations for the design and display of your simulation lab can dramatically increase learner buy-in!
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  7. The Sim Tech Hands-On Training event ‘SimGHOSTS’ is Hosting their 3rd Annual Event this August – Join over 200 other Healthcare Simulation Technicians at the San Antonio College Nursing and Allied Health Complex this August 6th – 9th for the global healthcare simulation event designed to provide a meeting place for Technicians to exchange ideas and network with technical peers as well as receive specialized training in manikin hardware repair & software programming, audiovisual equipment debugging, IT infrastructures, moulage makeup, team communication & leadership techniques, medical physiology and much more.
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  8. Consider Why & How to Build a Website For Your Medical Simulation Program, and How to Add Multimedia to Increase Marketing to Community & External Businesses – Benefits of creating a Simulation Program Website include: Community public relations, recruitment advertising and promotional marketing, providing contact information and capturing donations, as well as hosting student, staff, clinical educator/faculty resources. In the second article, learn how to add multimedia to further support these objectives!
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  9. Designing Prehospital Medical Simulation Scenarios – This guest author paper outlines the four stages that should be considered by tutors before their students are exposed to clinical simulation scenarios for educational purposes. These stages of paramedic education are relatively unique since the teaching and understanding of logistical considerations are not necessarily a significant concern to other clinicians from wider health disciplines.
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  10. How To Evaluate Effectiveness of Medical Simulations – Learn why simulation scenario design requires ongoing review, how healthcare can make tiny improvements for continued success, and gain free evaluation tools from CAE Healthcare.

*BONUS Link* – For even more great content check out the Top 50 “Best Of 2012″ Medical Simulation Articles!

CAE Healthcare METI at IMSH 2012

METI, now a brand name of CAE Healthcare, was at IMSH 2012 this year demonstrating the company’s continued commitment to being a leader in healthcare education.  At IMSH, I spoke with Regional Sales Director Brian Donohue about what this merger means for the medical simulation community as well as what we can expect from CAE Healthcare in 2012.

Also, be sure to check out my preview demonstration of the CAE Viamedix Ultrasound Simulator.  What really excites me about this merger is the amazing potential CAE now has to bring lessons learned from over half-a-century of simulation in aviation and other massive industries to the medical simulation community.

Now that METI is under the umbrella of CAE Healthcare and will have access to all this additional experiences I have a strong feeling we will be seeing a lot more trend-setting announcements from the company in the years to come.

Check out this amazing CAE 3000 helicopter simulator to see what I am talking about!

 Visit CAE Healthcare and METI to learn more.